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_,Waste Tire <br />State of California <br />CIWMB 183 (New 04104) <br />California Integrated Waste Management Board <br />SL rey & Inspection Repk. <br />Comments Form <br />SURVEY REQUIRED <br />BLUE OR BLACK INK PEN <br />Business Profile Inspection Details <br />f'� Inspection e� /� In <br />Site Suffix: / - ® Number: ReportI 2 O 3 V <br />Inspection Number on the associated Survey form (Page 1) <br />Comments <br />LAIU4e,'1�� , MGt •-,t��l �► t�rl S� e. Lt ! r 1 _(XA - <br />n+ LS c.0 <br />I <br />A 11144A 4 V� <br />127Cyi 1A1 <br />"k_ (sG Gt vi 0 <br />\i44, :R�,r fo 41'res p <br />N1 tkas <br />ONYMA <br />{, 'Kv <br />I MAC V)alo� A— if <br />J� P l- E, 1 2 .i <br />White Copy: CIWMB Yellow Copy: Operator Pink Copy: LEA <br />42408 <br />